P&R Dental Strategies: Bringing Big Data to Dental

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Paul T. Sheils, CEO, P&R Dental StrategiesPaul T. Sheils, CEO
The doors of the conference room are shut; attendees who were minutes too late are turned away. Inside, a standing-room-only crowd has formed in the largest meeting space at NADP CONVERGE, the biggest convention in the world of dental insurance. The room waits to learn what’s coming next for a rapidly evolving industry, to see what trends are more than just hype and to hear what the data has to say. The presenters are Mike Urbach, President, and Ty Hamilton, Chief Operating Officer, of P&R Dental Strategies. They have become the premier big data and analytics company in the market. They are the authority on what is happening in the dental market today and what may change tomorrow. However — this wasn’t how P&R began.

Founded in 1995 by dentists Dianne Rose and Anthony Paciello, P&R built its reputation in the dental industry by providing top-quality professional claim review services. While claim review remains a core element of the business today, over the next two decades, P&R expanded its market presence and established itself as a premier “big data” and informatics player in the industry, delivering customized, actionable business intelligence to support a variety of dental payer objectives. (Drs. Rose and Paciello sold the company and retired from day-to-day operations in 2015.)

Here’s how that evolution happened.

According to CEO Paul T. Sheils, who joined the company in 2015, the idea to become a “big data” player came from P&R President Mike Urbach. “When Mike joined the Company in 2007, large, “benchmark” databases were common in the medical space, where Mike had worked for over a decade. Mike drew on his rich prior experience in the medical data and informatics space to push P&R into the “big data” arena,” says Sheils. “Since P&R was already receiving a small percentage of clients’ claims for claim review, Mike argued that if the company were able to get all the claims from its clients, it could build a benchmarking database and use that database to deliver highly valuable, actionable intelligence back to the clients.”

Ten years later, P&R’s DentaBase® is the largest multi-payer claims database in the industry, with over 65 national and regional dental plans contributing data to the database, which has over 3 Billion dental procedures, and 1 claim in the last 60 days from 93% of the actively practicing dentists in the U.S.

Sheils, Urbach and Hamilton have developed DentaBase® into the most sophisticated analytics platform in the dental industry, providing unmatched business intelligence solutions and insights. P&R provides dental insurance payers a unique perspective on performance benchmarking to support their strategic and tactical objectives.

They’ve become the premier source for dental insights and they’re optimizing the dental industry one data analysis at a time.

The company’s solutions help payers optimize and improve everything from cost containment and quality of care to utilization and network management. P&R is also very serious about security and privacy, obtaining the coveted HiTrust® CSF certification last year.

“Every payer has a unique set of challenges and ambitions.” says Urbach, “With varying structures, sizes, geographies, members, cultures and technology adoption rates, P&R conducts a customized assessment for each client. Think of it like a diagnostic assessment one would get when visiting one’s personal physician for an annual check-up. These assessments can highlight inefficiencies in a payer’s utilization management operations and even uncover dental fraud, waste and abuse that their current processes may be overlooking.”

More than just static reports, P&R’s assessments provide a baseline for actionable intelligence to optimize operations. For example, to control “outlier” behavior and improve efficiencies, payers can deploy P&R’s Pronto® Smart Claim Selection Platform, which uses advanced algorithms to select which of the thousands of claims received each day should be sent for review by a licensed dentist. “Pronto takes the guesswork out of claim selection and replaces it with science,” says Hamilton.

Payers looking to expand their dental networks can license P&R’s Network Development Module™ to find new dentists that best fit their corporate objectives and gain valuable insights into the complexities of group practice affiliations including Dental Service Organizations.

One of P&Rs newest initiatives is designed to address the growing demand by payers and consumers for an objective, data-driven way to measure quality in dentistry. P&R’s new DentaQual® quality measurement platform has an answer. For years, medical doctors and hospitals have been rated and measured using objective data. In the dental market, however, dental consumers are forced to rely on questionably sourced user reviews, and sponsored advertisements to make decisions about quality. P&R’s DentaQual is the first, truly objective dental quality measurement platform: it rates individual dentists on metrics such as clinical competence, adherence to protocols and patient retention, by comparing individual dentists to their geographic peers by specialty. “DentaQual generates a simple quality score that empowers patients to select a dentist that best fits their needs and serves as a powerful marketing tool for the dentist,” says Hamilton.

As the dental industry continues to evolve, dental payers are increasingly searching for a “single source of truth,” which P&R’s industry-leading big data and analytics platform provides. “P&R has positioned itself as the authority on dental quality, data, measurement, analytics and technology,” added Sheils.” “Thanks to our industry-leading data assets, deep domain experience and highly talented team of professionals, P&R has become the trusted ‘go-to’ source for how dental insurance payers can optimize and improve their operations.”

P&R Dental Strategies News

Premier Imaging System Elevating Claim Imaging Efficiency to Add Value to Payers

Amid the proliferation of data from multiple sources, big data and analytics are rapidly gaining traction in the dental insurance industry.

FREMONT, CA: The premier dental insights company, P&R Dental Strategies, unveils the newest version Rapid Review Imaging System™ (RRIS). The new model is set to provide—with its capture technology, image enhancement algorithm, and higher quality camera—considerable saving for organizations by elevating claim imaging efficiency. Its design allows for optimal image quality and eliminates hours of image capture. RRIS also facilitates dental consultants to review with confidence, accelerating reviewer workflow, and reducing the need to suspend claims.
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